Active NPI
Alexander Kyle Tatum
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1316435423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.010516
- Practice address
- 5412 N Clark St Ste 212
Chicago, IL 60640-1273 - Phone
- (773) 257-3606
- NPI assigned
- Apr 24, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.010516 | IL | Primary |
Addresses
Primary practice location
5412 N Clark St Ste 212
Chicago, IL 60640-1273
Mailing address
5412 N Clark St Ste 212
Chicago, IL 60640-1273
Phone (434) 284-3806
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 4, 2021 through Jun 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.010516 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Radical Authenticity & Wellness Psychotherapy Group LLC | Clinical | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Chicago, IL
- NPI 1538875687
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769990400000",
"number": "1316435423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5412 N CLARK ST STE 212",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401273",
"telephone_number": "434-284-3806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5412 N CLARK ST STE 212",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401273",
"telephone_number": "773-257-3606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATUM",
"first_name": "ALEXANDER",
"middle_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-24",
"last_updated": "2026-02-02",
"certification_date": "2026-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.010516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.